Friday, January 4, 2008

Defining Depression

How do you know when the "Blues" have gotten out of hand and you need medication to be able to get past it?
Not related to post partum depression, just an over load of stress and crap in life. Is it possible to expect to get back off the medication some day?
If you don't have a GP, where do you start? I go to my OB/GYN annually for my medical needs.

This is probably one of the MOST common questions Social Workers, Doctors, Nurses, Nurse Practitioners, Counselors,Psychologists, and Psychiatrists hear.

Almost everybody gets the "Blues" from time to time. But there are definite signs and symptoms that differentiate the Blues from a Depression that can be treated with medication and/or therapy.

I need to take a detour here onto one of my famous tangents [if you read my other blog, you've been on one of my "Tangential Thinking Road Trips" before]. I am one of those helping professionals who believe that therapy never hurt anyone and has helped just about every one who gave it an honest try. So IF you meet the criteria for Depression, please consider therapy as well as medication.
I also attended the Nature and Nurture School of Causation for Depression. I think there is, in addition to the neurotransmitter/chemical imbalance component of depression, something in almost every one's background that contributed to their depression. Does this make you nuts? NO, it does not! Is it a criticism of your Mother or Daddy or the way they raised you? Not necessarily, unless you were abused physically, sexually, or emotionally. Or neglected physically or emotionally. The point is: YOU get to set the parameters for discussion in therapy. And, you can say ANYTHING within the confines of your therapist's office and it's confidential. Now, I know there may be a smart-ass or two out there to nit pick that last I have to include this modifier: if you tell your therapist you are planning to harm another person said therapist is obligated to inform the authorities and your intended victim [I think]. But that is the only time they are allowed to violate your confidentiality.

OK, side trip over, let's get back to the main topic...
I went to some websites I found through, my search engine of choice, using Depression Symptoms as my search criteria. These come from the National Institutes of Mental Health website,, just in case you want more info than what I'm relating here. I also liked their definition of Depression: When a person has a depressive disorder, it interferes with daily life, normal functioning, and causes pain for both the person with the disorder and those who care about him or her. Depression is a common but serious illness, and most who experience it need treatment to get better.

Here are the symptoms:
Persistent sad, anxious or "empty" feelings
Feelings of hopelessness and/or pessimism
Feelings of guilt, worthlessness and/or helplessness
Irritability, restlessness
Loss of interest in activities or hobbies once pleasurable, including sex
Fatigue and decreased energy
Difficulty concentrating, remembering details and making decisions
Insomnia, early–morning wakefulness, or excessive sleeping
Overeating, or appetite loss
Thoughts of suicide, suicide attempts
Persistent aches or pains, headaches, cramps or digestive problems that do not ease even with treatment

As for the 2nd part of the writer's email: Where to start if you don't have a GP, or Primary Care Physician and only see an OB/Gyn once a year for Well Woman Check-ups? There are, in most communities, mental health resources even for people without insurance. I don't know where this particular person lives. In Texas, we have an agency known as Mental Health/Mental Retardation [how UN-PC of us!!] or MH/MR. They accept anybody. The charges will be based on your ability to pay. If you are employed, but have no insurance, the eligibility worker will look at your income, family size and other medical expenses. Your fee per service, both medicine and therapy will be based on a sliding scale.

But, if you have private insurance, you will need to check your individual plan's coverage and requirements before beginning therapy. They may require you to only see provider's from an approved group of professional with whom they have negotiated fees. Otherwise your benefits may be reduced.

When seeking a physician to prescribe anti-depressant medication, I think it's important to consult a psychiatrist. They are specialists. All they do is treat disorders like depression. Their expertise can be invaluable in choosing the right medication for you. Often a medication regimen must be tweaked over a period of time before finding the correct dosage or even the correct medicine or combination of medicines for a particular patient. This is not a process to be left in the hands of the physician who goes from room to room treating coughs one minute and a sprained ankle the next, and then someone else's hypertension.

Trust me on this, even if it costs a little extra for the co-pay, go to the Shrink. They know their stuff. And don't get discouraged if the first medicine doesn't work. Or if your dosage has to be increased. Or if it has to be changed after 6 or 9 or 12 months. These things happen in a large percentage of cases. Treating Depression isn't like treating an ear infection or bronchitis. It's not one medicine works for everybody.

In the last 32 years, I've been on at least 13 different anti-depressants. So I know what I'm talkin' about when I speak of tweaking doses and making other adjustments. The brain is an amazingly adaptable organ. You put one chemical into it long enough and it will accommodate that chemical to the point where you have to try another chemical to achieve the same balance of Serotonin and Norepinephrin [the two neurotransmitters that get out of whack when we're depressed].

I think I answered the questions. If anybody is still in doubt after this and going to the NIMH site, leave me a comment or send me another email and I'll take another shot at it.

Tomorrow I answer a question about being a Parole Officer by someone considering a Career change.


jon said...

First, thanks for your post. Depression is not something willed away, like many think. It can be a lifetime concern, but medications and, sometimes, therapy keep the beast in the pit.

I've dealt with depression of a close family member for almost my entire life. I don't know if there is any real way to describe the effect on those that are close, but it can be terrible. Depression takes no prisoners. Education and psychiatrist are life savers. So are people like you that fight the good fight

knitalot3 said...

Thanks for the info. Very helpful.

roseviji said...

Hi guys,
There are a variety of different mental health disorders that can be associated with dual diagnosis. Anyone knows about dual diagnosis?
Dual Diagnosis.

Anonymous said...

It is important to remember that feelings of anxiety are normal and essential for living our daily lives. However, when these feelings become excessive and start interrupting a person's daily functioning, it becomes necessary to take treatment. If you feel you are experiencing unnecessary anxiety in your daily life take immediate help of your primary care physician. He or she can refer you to appropriate treatment centers or mental health professionals.